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W. D. Form 4 I500 J-I-17 C.P. <br /> " C1TY OF EVERETT�=Water Department " <br /> Application for Water <br /> All blanks must be filled in or crossed out � <br /> Everelt,___""_..""'___"'��_�""'_"_191 h'4 .: <br /> � TO THE SUPERINTENDENT OF THE WATER DEPARTMENT, <br /> C[TY OF EYERETT: <br /> � I hereby apply for the use of water in accordance with the nles and regula- �' <br /> tinns of The Water llepartmen4 for purposes and fixtures stated below. <br /> During the time that any oi the water mains m�.y be taken up by reason of � <br /> any imorovements authorized by the City of Everett,i..or ot any strcet nr atley in <br /> which they may have been laid, the City will uot 6e required to(urnish water during <br /> [he proqreas of auch improvemen[s to any consumer whnse supply may [hus bt cut <br /> nff,or be 1ia61e for any damages (nr i[s failure so to do. <br /> APPlicetionNo.----�-�t �'s-"' ' <br /> Block .----------' -----Lot----" -"'---Add_��-�c.� <br /> Nn._- �--- O <br /> --"--- <br /> - -- --- ------�--z Z--tJ?..street <br /> -----�--- ---------�?-'------ ----- -- <br /> ------------------ ---- <br /> - -- <br /> "fhe work to be exew[ed by________________ ________,___.___.__ p�umber - <br /> S[at siae of tap. _ <br /> _���__Tap to be inser[ed in fhe main. ��� l�'O � - <br /> ' ----____._Water closet � , <br /> ____'____Bath "- " <br /> ___.____ .Urinel <br /> ._________Plain faucet inside <br /> ' .________Side walk washer <br /> - _______._Hosebiboutside <br /> .________.Hose bib for building purposes ; <br /> ---___.__Hose bib inside - <br /> . --______._Bibforstablecon[aining._______.__stall_...___. <br /> � ____._____Number of persons in family <br /> __________Number of rnoms in huilding <br /> "Che premises are to 6e used as a__________________________,____ <br /> '___'. <br /> The nwner of!Se premises is _____._ <br /> ___"___._'___'____'__'____""__"__'___ <br /> Theagenti� ._""___".._.__"______'___' "___'.""_ <br /> ""___.'___"__'_" <br /> This applica[ion,al[hough siEned, shall not be binding upon [he City, until ao <br /> cep[ed by The Superintenden[of thc Wutcr Depar[men[. <br /> S�Bned_" "-"'_'_""_�___________________ _"___""_APPlicant . <br /> Accepted._"_______"_"____191 I3y____..____"__'___"' <br /> -�� c superlmendem " <br /> �2 ,��^ _�.,7�. C__ � <br />